Patients as healthcare consumers in the public and private sectors: a qualitative study of acupuncture in the UK

Felicity L Bishop,George T Lewith,Philippa Lee,Fiona Barlow,Beverly Coghlan

doi:10.1186/1472-6963-11-129

Felicity L Bishop, George T Lewith + Show 3 more

Open Access

https://doi.org/10.1186/1472-6963-11-129

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Abstract

BackgroundThe aim of this study was to compare patients' experiences of public and private sector healthcare, using acupuncture as an example. In the UK, acupuncture is popular with patients, is recommended in official guidelines for low back pain, and is available in both the private sector and the public sector (NHS). Consumerism was used as a theoretical framework to explore patients' experiences.MethodsSemi-structured face-to-face interviews were conducted in 2007-8 with a purposive sample of 27 patients who had recently used acupuncture for painful conditions in the private sector and/or in the NHS. Inductive thematic analysis was used to develop themes that summarised the bulk of the data and provided insights into consumerism in NHS- and private practice-based acupuncture.ResultsFive main themes were identified: value for money and willingness to pay; free and fair access; individualised holistic care: feeling cared for; consequences of choice: empowerment and vulnerability; and "just added extras": physical environment. Patients who had received acupuncture in the private sector constructed detailed accounts of the benefits of private care. Patients who had not received acupuncture in the private sector expected minimal differences from NHS care, and those differences were seen as not integral to treatment. The private sector facilitated consumerist behaviour to a greater extent than did the NHS, but private consumers appeared to base their decisions on unreliable and incomplete information.ConclusionsPatients used and experienced acupuncture differently in the NHS compared to the private sector. Eight different faces of consumerist behaviour were identified, but six were dominant: consumer as chooser, consumer as pragmatist, consumer as patient, consumer as earnest explorer, consumer as victim, and consumer as citizen. The decision to use acupuncture in either the private sector or the NHS was rarely well-informed: NHS and private patients both had misconceptions about acupuncture in the other sector. Future research should evaluate whether the differences we identified in patients' experiences across private and public healthcare are common, whether they translate into significant differences in clinical outcomes, and whether similar faces of consumerism characterise patients' experiences of other interventions in the private and public sectors.

Highlights

The aim of this study was to compare patients’ experiences of public and private sector healthcare, using acupuncture as an example
These participants were acting like the “consumer as chooser” [14] in that they were making an active decision to seek acupuncture. They emphasised their willingness to pay for an effective treatment and judged their experiences on that basis. This suggests an additional face of consumerism in private sector healthcare: the consumer as pragmatist, who emphasises the likely health effects of their choices
In conclusion, patients using acupuncture experienced it quite differently in the National Health Service (NHS) compared to the private sector

Summary

Introduction

The aim of this study was to compare patients’ experiences of public and private sector healthcare, using acupuncture as an example. Patients in the UK typically access health care through the National Health Service (NHS), which is free to all at the point of use. They have the option to access health care through the private sector, which is paid for through private insurance schemes or directly out-ofpocket. While personal financial resources are an important determinant of accessing private sector healthcare, psychological and sociological factors are relevant. Those with more conservative political attitudes are more likely to use private healthcare and less likely to use public healthcare than others [2]. Others have suggested that patients are pushed from public to private healthcare as a consequence of poor quality ( longer waiting lists) in the public sector [11]

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